Plantar fasciitis is a disorder of the foot’s connective tissue involving the plantar fascia, a thick band connecting the heel bone to the toes. When this tissue is overstressed, small tears and degeneration occur, leading to pain and discomfort. The most common symptom is a sharp, stabbing sensation in the heel, typically worst with the first steps taken in the morning or after a period of rest. Finding the appropriate healthcare professional is often necessary to achieve full relief and prevent recurrence.
Starting the Journey: Primary Care Assessment
The general practitioner (GP) or primary care physician (PCP) is the initial point of contact for most people experiencing heel pain. The PCP diagnoses the condition through a physical exam and patient history, checking for tenderness and ruling out other causes like a stress fracture or nerve entrapment. Imaging, such as X-rays, is usually not needed unless a fracture or serious pathology is suspected.
Once diagnosed, the PCP establishes a conservative, first-line treatment plan. This management includes recommending activity modification, such as reducing high-impact exercise, and advising on over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) for pain control. They also provide simple home-stretching exercises for the plantar fascia and calf muscles. The PCP coordinates care, making a referral to a specialist if symptoms do not improve after four to six weeks of conservative measures.
Consulting the Specialists: Podiatrists and Orthopedists
When initial care fails to resolve the heel pain, the patient is typically referred to a specialist, either a podiatrist or an orthopedist. A podiatrist (Doctor of Podiatric Medicine or DPM) specializes exclusively in the feet, ankles, and lower legs. They possess expertise in foot biomechanics, managing the majority of chronic plantar fasciitis cases. Podiatrists frequently prescribe custom-fitted orthotics to support the arch and distribute pressure evenly across the foot.
These specialists administer in-office procedures for stubborn cases, such as corticosteroid injections into the painful area, though multiple injections are avoided due to the risk of tissue weakening. They may also recommend advanced non-invasive therapies, like extracorporeal shockwave therapy (ESWT), if the pain is unresponsive after several months of conservative care. An orthopedic surgeon (MD or DO) treats the entire musculoskeletal system. They are generally consulted when the pain is severe or when surgical intervention is being considered. The surgical procedure, called a plantar fasciotomy, is a rare option reserved only for cases that fail to respond after six to twelve months of exhausting all non-operative treatments.
Essential Support: Physical Therapy and Rehabilitation
Physical therapists (PTs) support the management of plantar fasciitis, working in conjunction with the prescribing physician. PTs focus on long-term recovery and preventing the recurrence of heel pain by addressing underlying mechanical issues. They guide patients through specific stretching and strengthening routines designed to improve the flexibility of the plantar fascia and reduce tightness in the Achilles tendon and calf muscles.
The physical therapy regimen includes targeted exercises, such as towel scrunches to strengthen intrinsic foot muscles and heel raises. PTs may also use manual therapy techniques, including soft tissue manipulation or instrument-assisted soft tissue mobilization, to break up scar tissue and reduce tension. A physical therapist can also perform a gait analysis to correct abnormal walking patterns that might be contributing to the strain on the foot.